Provider Demographics
NPI:1467431296
Name:HAQ, SYED EAJAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:EAJAZ
Last Name:HAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EAJAZ
Other - Middle Name:ULHAQ
Other - Last Name:SYED
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:474 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE4
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2647
Mailing Address - Country:US
Mailing Address - Phone:716-833-3697
Mailing Address - Fax:716-833-3698
Practice Address - Street 1:474 NIAGARA FALLS BLVD
Practice Address - Street 2:SUITE4
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-2647
Practice Address - Country:US
Practice Address - Phone:716-833-3697
Practice Address - Fax:716-833-3698
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119740207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00606506Medicaid
NY00606506Medicaid